Evaluation of Diarrhoea Developing in an Inpatient Population: The Importance of Microbiological Investigations, Medications and Feeding

The purpose of this study was to evaluate the investigations performed in an unselected group of inpatients in a tertiary referral hospital, who developed diarrhoea during their hospital stay.

Method: Over 18 working days, inpatients who developed diarrhoea since their admission to hospital were reviewed. Symptoms, medications and nutritional support were assessed. The microbiological, radiological and endoscopic investigations, if performed, together with any treatments were also reviewed.

Results: 81 patients, 47 males (58%), mean age 65 years, over 18 working days were found to have diarrhoea. 24 patients (29.6%) were awaiting long-term placement. The mean duration of symptoms was 5.4 days. 49 patients (60.5%) were receiving antibiotics prior to the development of symptoms. 30 patients (37%) were being enterally tube fed while 3 (3.7%) were on total parenteral nutrition. 17 patients (21%) were prescribed NSAIDs. 14 (17.3%) had positive stool for Clostridium difficile A and B toxin. 3 patients (3.7%) had salmonella sp positive stool. The patients with Clostridium difficile were treated with Metronidazole. 3 patients died during the course of the study from causes unrelated to their diarrhoea.

Conclusion: The majority of cases of diarrhoea were related to medications, particularly antibiotics, and enteral tube feeding. However a small but significant number did develop Clostridium difficile and other bacterial infections. In investigating patients who develop diarrhoea in hospital it is therefore worth performing microbiological examinations.